- Email: [email protected]
P-29
serum leptin and follicular fluid leptin, estradiol, and progesterone with IVF outcomes. DESIGN: Prospective Cohort. MATERIALS AND METHODS: Ten patients were enrolled during a single IVF cycle. Serum leptin levels were obtained at six different times during the IVF stimulation cycle and follicular fluid leptin, progesterone, and estradiol were obtained at the time of oocyte retrival. Follicular fluid levels of leptin, estradiol, and progesterone were measured via enzyme immunoassay. RESULTS: Serum leptin and estradiol levels both significantly increased for the individual patients during the IVF stimulation process (p ⬍ 0.05). None of the leptin levels differed based on pregnancy outcome. All leptin levels correlated significantly with other serum and follicular fluid leptin levels throughout the IVF cycle (p ⬍ 0.01). BMI significantly correlated with all leptin levels (p ⬍ 0.01). Follicular fluid leptin, estradiol, and progesterone levels did not correlate with each other, indicating independent regulation. Interestingly, follicular fluid estradiol levels correlated with serum estradiol levels only in patients with a positive pregnancy outcome (r ⫽ 0.97, p ⬍ 0.01) whereas serum and follicular fluid estradiol were unrelated in patients that did not achieve a successful pregnancy (r ⫽ 0.14, p ⫽ 0.81). No other correlations were found between serum or follicular fluid leptin levels and patient demographics, IVF pre-stimulation parameters, IVF stimulation parameters or IVF cycle outcomes. CONCLUSION: Leptin levels significantly increased during the IVF cycle and varied between patients based on BMI. Leptin levels seem to respond to gonadotropin stimulation but do not correlate with serum or follicular fluid hormone levels. Leptin follicular fluid levels are directly related to serum leptin levels. While we did not identify a dependency of pregnancy outcome on leptin, it appears that pregnancy outcome success may be reflected in the relationship between follicular fluid and serum levels of estradiol, independent of leptin levels. Supported by: Department of Obstetrics and Gynecology, Tripler Army Medical Center.
P-29 CHANGES IN MEASURED ENDOMETRIAL THICKNESS PREDICT IN VITRO FERTILIZATION SUCCESS. J. L. Frattarelli, G. D. McWilliams. Reproductive Medicine Associates of New Jersey, Somerset, NJ; Tripler Army Medical Center, Honolulu, HI. OBJECTIVE: Few studies have evaluated the change in endometrial thickness occurring during IVF stimulation. Based on the lack of available literature, this study was designed to assess the predictive ability of endometrial thickness and changes in endometrial thickness on pregnancy outcomes in patients undergoing in vitro fertilization. DESIGN: Retrospective cohort analysis. MATERIALS AND METHODS: The patient population consisted of 132 infertility patients undergoing 132 fresh autologous IVF cycles. All patients received a transvaginal ultrasound to assess endometrial thickness at three defined points during IVF ( 1. at baseline after pituitary suppression before gonadotropin stimulation, 2. on the 6th day of gonadotropin stimulation, and 3. on the day of hCG administration). Primary outcome variables included endometrial lining thickness at baseline, on day 6 of gonadotropins, the day of hCG administration, and the change in endometrial thickness during gonadotropin stimulation. RESULTS: Patients attaining pregnancy had significantly greater endometrial thickness on day 6 (p ⬍ 0.001) and endometrial thickness on day of hCG administration (p ⬍ 0.05). Pregnant patients had a greater change in endometrial thickness from the baseline to day 6 (p ⬍ 0.05) when compared to non-pregnant patients. Threshold analysis and receiver-operator characteristic curves noted significant endometrial thickness levels for implantation and pregnancy rates. An endometrial thickness on day 6 of ⬍ 6 mm was found to have a significantly lower implantation rate (17.1% versus 33.3%) (p ⬍ 0.001, RR ⫽ 0.51 (0.34, 0.77)) and pregnancy rate (38.0% versus 64.5%) (p ⬍ 0.01, RR ⫽ 0.59 (0.40, 0.87)) than an endometrial thickness of ⱖ 6 mm. A change in endometrial thickness from baseline to day 6 of ⬍ 3 mm was found to have a significantly lower implantation rate (22.4% versus 35.7%) (p ⬍ 0.01, RR ⫽ 0.63 (0.44, 0.88)) than a change in endometrial thickness of ⱖ 3 mm. A change in endometrial thickness from baseline to day 6 of ⬍ 2 mm was found to have a significantly lower pregnancy rate (42.0% versus 62.7%) (p ⬍ 0.05, RR ⫽ 0.67 (0.46, 0.97)) compared to a change in endometrial thickness of ⱖ 2 mm.
FERTILITY & STERILITY威
CONCLUSION: Endometrial responsiveness and thickness during the early IVF stimulation seem to be better prognostic predictors of success than endometrial thickness at the start or the end of the IVF cycle. Increased endometrial responsiveness seen on day 6 of gonadotropin stimulation as compared to the baseline is important to IVF success. Endometrial thickness during the early part of the IVF cycle seems to be a more important prognostic variable than does endometrial thickness at the start or end of the IVF cycle. Supported by: None.
P-30 TRANSFER OF AT LEAST ONE EXPANDED BLASTOCYST ON DAY 5 IS A GOOD PROGNOSTIC INDICATOR OF PREGNANCY. S. Kirkpatrick, E. Silverstein, M. Wilson, S. Nunn. The Fertility Center of Colorado, Colorado Springs, CO. OBJECTIVE: To evaluate ongoing pregnancy rates when at least one expanded blastocyst is transferred on Day 5. DESIGN: A retrospective analysis of Day 5 embryo transfers (ET) performed between January 2002 and January 2004. MATERIALS AND METHODS: We reviewed 86 Day 5 fresh embryo transfers of patients who underwent controlled ovarian hyperstimulation for IVF. Stimulation protocols included down regulation with Leuprolide Acetate, microdose Leuprolide Acetate flare, or GnRH antagonist suppression. Recombinant FSH and/or human menopausal gonadotropin (hMG) were used prior to administration of human chorionic gonadotropin (hCG) for follicular maturation. Transvaginal oocyte retrieval was performed 36-38 hours after hCG. Oocyte insemination took place 40 - 42 hours after hCG. Fertilization was assessed at approximately 18 hours after insemination. Fertilized oocytes were grouped and cultured in G1 (Vitrolife) microdrops under oil through Day 3. Embryos then were moved to microdrops of G2 (Vitrolife) media for culture through Day 5. Embryo transfers were performed on Day 5 in G2 (Vitrolife) media using Wallace embryo transfer catheters. Blastocyst development was assessed as follows: a) early blastocyst (EB)- blastocoel is less than 50% of embryo volume and there is no thinning of the zona; b) blast (B)- blastocoel is greater than 50% of embryo volume and there is no thinning of the zona; and c)expanded blastocyst (XB)- blastocoel completely fills the embryo and the zona is noticeably thinning. RESULTS:
CONCLUSION: While we do not have enough data to show statistical significance, we can certainly see a trend. A patient that has at least one expanded blastocyst for transfer on Day 5, has a greater than 80 % chance of ongoing pregnancy. Supported by: None.
P-31 LUTEAL PHASE RECOMBINANT FSH AS A NOVEL STIMULATION PROTOCAL IN THE IVF POOR RESPONDER. S. Kansal Kalra, C. R. Gracia, L. Martino, K. T. Barnhart. Hospital of Univ of Pennsylvania, Philadelphia, PA. OBJECTIVE: It has been shown that FSH first begins to rise in serum 12 days after ovulation suggesting that recruitment of follicles for the next
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P-29 CHANGES IN MEASURED ENDOMETRIAL THICKNESS PREDICT IN VITRO FERTILIZATION SUCCESS. J. L. Frattarelli, G. D. McWilliams. Reproductive Medicine Associates of New Jersey, Somerset, NJ; Tripler Army Medical Center, Honolulu, HI. OBJECTIVE: Few studies have evaluated the change in endometrial thickness occurring during IVF stimulation. Based on the lack of available literature, this study was designed to assess the predictive ability of endometrial thickness and changes in endometrial thickness on pregnancy outcomes in patients undergoing in vitro fertilization. DESIGN: Retrospective cohort analysis. MATERIALS AND METHODS: The patient population consisted of 132 infertility patients undergoing 132 fresh autologous IVF cycles. All patients received a transvaginal ultrasound to assess endometrial thickness at three defined points during IVF ( 1. at baseline after pituitary suppression before gonadotropin stimulation, 2. on the 6th day of gonadotropin stimulation, and 3. on the day of hCG administration). Primary outcome variables included endometrial lining thickness at baseline, on day 6 of gonadotropins, the day of hCG administration, and the change in endometrial thickness during gonadotropin stimulation. RESULTS: Patients attaining pregnancy had significantly greater endometrial thickness on day 6 (p ⬍ 0.001) and endometrial thickness on day of hCG administration (p ⬍ 0.05). Pregnant patients had a greater change in endometrial thickness from the baseline to day 6 (p ⬍ 0.05) when compared to non-pregnant patients. Threshold analysis and receiver-operator characteristic curves noted significant endometrial thickness levels for implantation and pregnancy rates. An endometrial thickness on day 6 of ⬍ 6 mm was found to have a significantly lower implantation rate (17.1% versus 33.3%) (p ⬍ 0.001, RR ⫽ 0.51 (0.34, 0.77)) and pregnancy rate (38.0% versus 64.5%) (p ⬍ 0.01, RR ⫽ 0.59 (0.40, 0.87)) than an endometrial thickness of ⱖ 6 mm. A change in endometrial thickness from baseline to day 6 of ⬍ 3 mm was found to have a significantly lower implantation rate (22.4% versus 35.7%) (p ⬍ 0.01, RR ⫽ 0.63 (0.44, 0.88)) than a change in endometrial thickness of ⱖ 3 mm. A change in endometrial thickness from baseline to day 6 of ⬍ 2 mm was found to have a significantly lower pregnancy rate (42.0% versus 62.7%) (p ⬍ 0.05, RR ⫽ 0.67 (0.46, 0.97)) compared to a change in endometrial thickness of ⱖ 2 mm.
FERTILITY & STERILITY威
CONCLUSION: Endometrial responsiveness and thickness during the early IVF stimulation seem to be better prognostic predictors of success than endometrial thickness at the start or the end of the IVF cycle. Increased endometrial responsiveness seen on day 6 of gonadotropin stimulation as compared to the baseline is important to IVF success. Endometrial thickness during the early part of the IVF cycle seems to be a more important prognostic variable than does endometrial thickness at the start or end of the IVF cycle. Supported by: None.
P-30 TRANSFER OF AT LEAST ONE EXPANDED BLASTOCYST ON DAY 5 IS A GOOD PROGNOSTIC INDICATOR OF PREGNANCY. S. Kirkpatrick, E. Silverstein, M. Wilson, S. Nunn. The Fertility Center of Colorado, Colorado Springs, CO. OBJECTIVE: To evaluate ongoing pregnancy rates when at least one expanded blastocyst is transferred on Day 5. DESIGN: A retrospective analysis of Day 5 embryo transfers (ET) performed between January 2002 and January 2004. MATERIALS AND METHODS: We reviewed 86 Day 5 fresh embryo transfers of patients who underwent controlled ovarian hyperstimulation for IVF. Stimulation protocols included down regulation with Leuprolide Acetate, microdose Leuprolide Acetate flare, or GnRH antagonist suppression. Recombinant FSH and/or human menopausal gonadotropin (hMG) were used prior to administration of human chorionic gonadotropin (hCG) for follicular maturation. Transvaginal oocyte retrieval was performed 36-38 hours after hCG. Oocyte insemination took place 40 - 42 hours after hCG. Fertilization was assessed at approximately 18 hours after insemination. Fertilized oocytes were grouped and cultured in G1 (Vitrolife) microdrops under oil through Day 3. Embryos then were moved to microdrops of G2 (Vitrolife) media for culture through Day 5. Embryo transfers were performed on Day 5 in G2 (Vitrolife) media using Wallace embryo transfer catheters. Blastocyst development was assessed as follows: a) early blastocyst (EB)- blastocoel is less than 50% of embryo volume and there is no thinning of the zona; b) blast (B)- blastocoel is greater than 50% of embryo volume and there is no thinning of the zona; and c)expanded blastocyst (XB)- blastocoel completely fills the embryo and the zona is noticeably thinning. RESULTS:
CONCLUSION: While we do not have enough data to show statistical significance, we can certainly see a trend. A patient that has at least one expanded blastocyst for transfer on Day 5, has a greater than 80 % chance of ongoing pregnancy. Supported by: None.
P-31 LUTEAL PHASE RECOMBINANT FSH AS A NOVEL STIMULATION PROTOCAL IN THE IVF POOR RESPONDER. S. Kansal Kalra, C. R. Gracia, L. Martino, K. T. Barnhart. Hospital of Univ of Pennsylvania, Philadelphia, PA. OBJECTIVE: It has been shown that FSH first begins to rise in serum 12 days after ovulation suggesting that recruitment of follicles for the next
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